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Questions for Dr. Kennedy
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questions about prolotherapy
Posted by: Justin
Date: January 22, 2003 2:58 AM

In prolotherapy what is the ideal time between treatments on the same joint?

Is it energetically unfavorable to interleave treatments, i.e. treat two or more joints back to back or alternating weekly? I had originally tried this, but then decided that concentrating on one joint at a time to the end of treatment may be better.

Regarding exercise, at what point in the treatment, assuming a multi-injection protocol, should I start looking at strengthening the rotator cuff muscles?

RE: questions about prolotherapy
Posted by: Ron Kennedy, M.D.
Date: January 22, 2003 11:24 AM

As with all medical procedures one has to take into considerations the unique characteristics of the person involved and look at the clinical course. Younger people heal faster and people who are older but who are on nutritional and hormone replacement programs also heal faster. Three is no one schedule which works for everyone. While one is experiencing pain from a previous injection there is inflammation underway, and that is the main clue we have to healing. When that is completely gone there is no reason not to proceed to the next treatment, although delaying will not compromise the final result. As to treating multiple joints the body's supply of fibroblasts should be adequate to cover all basis simultaneously. In emergency medicine we see people heal at a normal rate from, for example, multiple stab wounds, sometimes 10-20. That process calls for activity from the same cells. As to rotator cuff injuries, those should be studied with a gallium MRI and if positive followed by arthroscopic exam. Often there are conditions which must be handled surgically before healing can occur - such as frayed cartilage or tendons reduced in size by exostoses which have constricted the pathway through which the tendon slides. If that is the case one can expect nature to fully repair the damage within nine months after surgery, perhaps less with prolotherapy. When the shoulder is cleared by MRI or properly repaired by surgery, careful exercise can proceed according to pain levels. Any movement which causes more than an twinge of discomfort should be put off until it can be done relatively painlessly. Some small amount of pain is natural and normal in the strengthening process. Usually doctors enlist the services of a physical therapist in the first few months of healing from a surgical approach.

MRI question
Posted by: Justin
Date: January 24, 2003 6:01 PM

I have had three MRIs on the right shoulder after an initial diagnosis of supraspinatus tendonitis and instability. The cause was an identifiable overuse injury that took 24 hours to present symptoms. The first MRI was taken three months out, a few weeks following secondary injury a month and a half or so later and showed tendonopathy. The other two were taken 10 and 16 months from initial injury and showed nothing. I asked for a contrast on the third and they wouldn't do it. After three courses of physical therapy and several periods of laying off it spread out over a year and a half. I tried to gradually resume normal activities but never got more than about 70% function with manageable but recurring problems. Eventually the shoulder got to where it subluxed noticeably, even with non-strenuous exercise, and on two occasions the humeral head pulled slightly out of the socket then snapped right back in. I'm only 34 and before the injury 2 years ago competed seriously in several sports. Now I can do almost nothing athletic - nor can I do my job properly. I started prolotherapy in December, and have had three of five planned injections. Whether I am ready or not at the end of them, I am supposed to go on a three month active duty tour with the Army four weeks after the final one. Do you think a Gallium contrast MRI might show something perhaps the others didnít?

RE: MRI question
Posted by: Ron Kennedy, M.D.
Date: January 27, 2003 3:25 AM

Gallium brings out leakages and leakages occur when a tendon or tendon sheath is injured. It seems to me that would be the logical study to do.



This Thread has been closed

 




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